Men
Erectile Dysfunction
Erectile dysfunction (ED), describes a man’s inability to get or maintain an erection that’s firm enough for normal sexual intercourse. Normal is defined as 3-8 minutes of sexual intercourse, as the U.S. national average for vaginal intercourse is approximately 5 minutes. Erectile dysfunction ranges in severity from infrequent or minor, to complete and permanent impotence. Minor erectile problems include for example, when a man cannot achieve an erection on a fantasy or thought alone, or when an erection requires a couple of minutes to build up. With permanent impotence, even masturbation will not lead to an erection.
Dealing with erectile dysfunction can be very distressing, often leading to low self esteem and depression, not to mention serious marriage or relationship issues. Men often believe, simplistically, that any sex is good sex, and that good sex is as important to women as it is to them. While women also want a fulfilling sex life, studies have repeatedly shown that the topic doesn’t rank quite as high as it does for men. Moreover, female sexual fulfillment is not always dependent on having intercourse each time.
Erectile dysfunction may have nothing to do with low libido or a low sex drive. If you have erectile dysfunction, or if you have a partner with ED, the desire to have sex may be strong, while the ability to act on that desire just isn't there. That said, you can still get a lot of emotional and physical pleasure out of your sexual activities together without having intercourse.
The chance of havung erectile dysfunction increases with age. At age 40, approximately 40% of men will have a degree of ED. The prevalence will increase by around 10% each decade, so by the time a man reacches age 70, the chance of having ED increases to 70%.
Even younger men, including teenagers, can experience erectile dysfunction. Studies estimate 20-30% of men under 40 have had at least one experience with ED. The underlying causes are different, though.
For men younger than 40, most cases of erectile dysfunction are due to psychological factors such as performance anxiety (common when first having sex with a new partner), or overstimulation and desensitization caused by excessive porn use. Along the same vein, clinical depression, alcoholism, narcotics abuse, and periods of intense psychological stress can also lead to erectile dysfunction in young men. The good thing is that psychogenic ED, is nearly always reversible with appropriate treatment.
Erectile dysfunction in older men can be more serious, and is often the result of health issues leading to damaged blood vessels in the penis. This eventually prevents blood from accumulating and staying in the penis long enough to develop or sustain a firm erection. The most common causes of vascular damage are high blood pressure, diabetes, high cholesterol and cigarette smoking. Obesity, lack of physical exercise, a poor diet, alcohol, drugs or medications, stress and a wide range of chronic health issues may also contribute to ED.
Low testosterone is often implicated in erectile dysfunction but is rarely an actual cause. A lack of testosterone can reduce sexual desire in men, but normally doesn’t impact the ability to obtain an erection erection unless other underlying health issues are involved.
That’s a question many people ask themselves, especially when first encountering erectile dysfunction in the context of a relationship. As mentioned before, erectile dysfunction doesn’t happen because of low sexual appetite. You or your partner may want to have sex, but either physically cannot, or are too scared of disappointment to even try.
It is first important to understand what’s causing the erectile dysfuncyion. In men younger than 40, who are generally in good health, and do not suffer from depression or substance abuse, it’s very likely that erectile dysfunction is purely psychogenic, and brought about by fear or anxiety. Another potential cause in a healthy, young male, is excessive porn use (more than 3-4 hours a week). Even after giving up porn completely, it can take 3 months or longer for the brain to learn how to respond to partnered sex again.
Try having an open, frank discussion about fear and anxiety as it relates to sexual activity. Making yourself or your partner feel comfortable can go a long way in treating erectile dysfunction caused by performance anxiety. Often, foreplay and the intimacy of being together can provide equal or even greater pleasure than the intercourse. Try to take the focus away from intercourse and concentrate on other sexual activities (oral sex, massages, sex toys, etc.). Sexual intercourse then becomes more of an option than an obligation, and is therefore less likely to induce anxiety.
For most young men, erectile dysfunction is only a temporary problem which will eventually resolve. If you feel that you need more help however, you might consider consulting a sexual therapist.
In men over age 40, physical health issues may be at the rout of erectile dysfunction. A change in the quality or duration of erections may herald the onset of ED. ED itself may indicate underlying cardiovascular disease. Therefore, when erectile dysfunction sets in, a full evaluation with a medical professional is essential. Early treatment with medication and lifestyle changes may be able to improve ED or prevent ED from worsening.
If erectile dysfuction is not psychogenic, or if lifestyke changes or therapy have not led to any improvement, there are several other options available.
A popular mechanical solution is a vacuum pump. This consists of a cylinder in which a vacuum is created through a hand or battery-operated pump, which erects the penis. To hold the erection in place a tight ring is then placed around the base of the penis. This practice provides approximatelyt 30 minutes of time during which intercourse can take place.
There are also are several effective medications avaialable.
The four drugs available on the U.S. market upon prescription are: Viagra (sildenafil), Cialis (tadalafil), Stendra (avanafil) and Levitra (vardenafil). All four are oral medications and most are available in generic form. Tadalafil is the only one of the three that’s approved for daily, long-term use.
All four drugs function in the same way: they dilate blood vessels in the penis, allowing for increased blood flow, which then leads to a firmer and longer-lasting erection. Current erectile dysfunction medications have an impressive success rate of up to 80%. Although the mehcanism of action is largerly the same, differneces in the chemical composition of ED medications affects speed of onset and duration of action. A licensed physician can tell you or your partner about these differences, in addition to potential side effects and potential interactions with other medications.
Reviewed by Dr Roy Kedem, MD
Information last reviewed 12/06/21
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